HACKED: The SEC’s X Account

By Staff Reporters

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SEC stands for the U.S. Securities and Exchange Commission which is an ...

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Everyone is waiting for the SEC’s decision, expected today, about whether it will allow spot bitcoin ETFs that would make buying the cryptocurrency easier and more accessible. But it seems someone wasn’t willing to wait it out!

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After the SEC’s account posted to X yesterday that the ETFs had been approved, Chair Gary Gensler said on his own account that there had been no approval and the agency’s account was “compromised.” The false post briefly caused a spike in bitcoin prices.

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PRIVATE HOSPITAL EQUITY: Adverse Events Rise?

By Staff Reporters

DEFINITION: Adverse events are medical errors that healthcare facilities could and should have avoided. The National Quality Forum (NQF) defines these errors, which are also called serious reportable events. There are 29 adverse events listed as reportable errors. The events may result in patient death or serious disability. The department manages aggregate data on adverse events and posts quarterly reports on this website.

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NEVER EVENTS: https://medicalexecutivepost.com/2007/12/20/new-never-events-policy/

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A hospital’s acquisition by a private equity firm is linked to a rise in adverse events despite the pool of lower-risk patients they tend to admit, according to a Medicare Part A claims analysis just published in the Journal of the American Medical Association [JAMA], and according to Dave Muoio of Fierce Healthcare.

JAMA: https://jamanetwork.com/journals/jama/article-abstract/2813379

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DAILY UPDATE: Stocks Rocket Back for Highest 2024 Close as Key Inflation Updates Loom

By Staff Reporters

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Here is where the major benchmarks ended:

Bond yields and stock prices often move inversely to each other, in part because higher interest rates on virtually risk-free bonds lower the premium investors can expect from riskier assets like stocks, making it less appealing to buy equities. Last week, the 10-year Treasury yield briefly increased to 4.10%, near a three-week high, before dropping back near 4% Monday.

  • The S&P 500 index was up 66.30 points (1.4%) at 4,763.54; the Dow Jones Industrial Average was up 216.90 points (0.6%) at 37,683.01; the NASDAQ Composite was up 319.70 points (2.2%) at 14,843.77.
  • The 10-year Treasury note yield (TNX) was down about 3 basis points at 4.015%.
  • The CBOE® Volatility Index (VIX) was down 0.28 at 13.07.

Semiconductors shares were among the strongest performers, helped by a surge of 6.4% in Nvdia Corp. (NVDA), the top 2023 performer in the S&P 500 with a gain of 239%. Small-cap stocks were also firm as were consumer discretionary and communication services. The Russell 2000® Index (RUT) gained 1.9% to partly climb back from last week’s 3.7% drop.

Energy shares were soft because crude oil futures sank nearly 4% following reports Saudi Arabia lowered its prices.

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PODCAST: Impact of Education on Employee Health Care

HEALTH INSURANCE DEMOGRAPHICS

By Eric Bricker MD

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DAILY UPDATE: Crypto-Currency, ETFs and the Stock Markets

By Staff Reporters

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The Markets as of 10:00am ET. Here’s what these numbers mean.
Markets: One week into 2024, stocks and bonds are off to their worst start in 21 years as investors maybe got a bit ahead of their skis in anticipating Fed rate cuts.

This week, Wall Street will be focused on fresh inflation data and the beginning of Q4 earnings season.

                        

Bitcoin ETF cleared for launch? The first spot bitcoin ETF—could be approved by regulators this week in what would be a watershed moment for Wall Street’s embrace of digital tokens. The hype around these proposed funds, which would allow regular investors to gain exposure to bitcoin without buying it directly, drove bitcoin’s price up 162% over the past year.

Here is where the major benchmarks ended:

  • The S&P 500 Index was up 84.15 points (1.9%) at 4,495.70; the Dow Jones Industrial Average (DJI) was up 489.83 points (1.4%) at 34,827.70; the NASDAQ Composite (COMP) was up 326.64 points (2.4%) at 14,094.38.
  • The 10-year Treasury note yield (TNX) was down about 18 basis points at 4.453%.
  • CBOE’s Volatility Index (VIX) was down 0.60 at 14.16.

The small-cap focused Russell 2000 Index (RUT), which has lagged large-cap benchmarks for most of the year, jumped more than 5% Tuesday. Small-caps are often seen as being more exposed to the economic cycle and had suffered because of concerns that high interest rates could push the economy into recession.

Other interest rate-sensitive sectors, such as real estate, materials, and utilities, also saw outsize gains.

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DAILY UPDATE: “Medical Properties Trust” Tanks, FDA Approves Canadian Drugs and Medicare Advantage Health Plan [Part C] Patient Traps

By Staff Reporters

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Markets: Stocks climbed a bit on Friday as investors took in the news that the US added more jobs than expected in December, capping off an epic 2023 for the labor market. But it wasn’t a bright start to the year, as all three major averages broke a nine-week winning streak. Stock spotlight: The country’s largest hospital landlord, Medical Properties Trust, tanked after revealing that its biggest tenant was $50 million behind on rent.

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Yesterday, the Food and Drug Administration (FDA) approved Florida’s request to import bargain medications from the country. It’s the first state to get permission from the agency to bring in medications from Canada under a law Congress passed 20 years ago to help Americans pay less for drugs. Florida officials say ordering cheaper drugs for conditions like HIV and diabetes from Canadian wholesalers will save Medicaid and other state programs $150 million over the first year.

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Older Americans say they feel trapped in Medicare Advantage plans.

READ HERE: http://tinyurl.com/yck2yb8z

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HUMAN TOUCH: Needed in Medicine

By Staff Reporters

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According to Fierce Healthcare, 60% of patients say they are willing to switch doctors for a better communications experience, according to a survey. Patients want more of a “human touch” when texting their providers, like conversational message exchanges. 

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IMPLICATION OF WITHDRAWALS IN A MODERATE INTEREST RATE ENVIRONMENT

  A SPECIAL ME-P REPORT

A Retrospective Review … and Implications for Modernity

[Copyright Manning & Napier Advisors, Inc.]

Dr. Jeff Coons

By Jeff Coons PhD CFA

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

The general trend of declining interest rates experienced over the last several decades, part of a long-term trend Manning & Napier Advisors, Inc. and others have focused on since the early 1980’s, created new challenges for managing investment portfolios with regular and significant cash withdrawals.

Historical Review

This continuing report, first prepared 25 years ago, will provide an analysis of the investment implications of withdrawals in light of the secular shift in the economic and market conditions today. This analysis and historical review aims to guide decisions as to the appropriate level of withdrawals from an account in the more current moderate interest rate environment of 2014; and estimated thru to 2023.

The Questions

Declining interest rates restrict the ability to generate income from high quality investments, so a greater proportion of a given withdrawal requirement must come from the potential price appreciation of the securities.  Of course, the inherently volatile nature of the financial markets makes price appreciation the less predictable of the sources of total return available to fund withdrawal needs.

The natural questions that arise from this observation include:

  • What withdrawal rate inhibits the ability to pursue long-term capital growth as a primary investment objective?
  • What withdrawal rate may create a significant risk of a sustained deterioration of capital?
  • What is a reasonable range of withdrawal rates given the relatively low interest rate environment that we face? 

The answer to the first question can be derived from interest rates and dividend yields.  With a dividend yield of 1.0%-2.0% on stocks (e.g., the yield on the S&P 500 Index as of December 2000 was 1.2%) and yields on intermediate-term and long-term fixed income securities between 5.0% and 6.0% (e.g., as of December 2000, a one-year Treasury Bill had a yield of 5.4% and a thirty-year Treasury bond had a yield of 5.5%), growth-oriented portfolios should generally produce a level of income adequate to allow 2.5%-3.5% withdrawals on an annual basis.

Thus, rates of withdrawal of less than 3.5% generally should not inhibit the pursuit of long-term capital growth as a primary investment objective.

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Portfolio analysis

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Management Approach

To establish the high end of the achievable withdrawals under a management approach pursuing long-term capital growth, consider some historical evidence.

Assume that withdrawals are taken from each of three portfolios (i.e., 100% stocks, 80% stocks/20% bonds, and 50% stocks/50% bonds using data from Ibbotson Associates, Inc.) starting at the beginning of 1973.  How many years did it take to regain the original capital of the portfolio?

As can be seen in the following table, it took between 4-8 years for these portfolios to recover from the 1973-74 bear market with a 5.0% withdrawal rate.  If withdrawals are at a 7.5% rate per year, over ten years elapsed before the original capital was restored.

Finally, with a 10.0% withdrawal rate, it took between 13-15 years to restore the capital.  While the 1973-74 bear market was severe, it is not the worst bear market that can be used to illustrate the risk of significant withdrawals taken when the portfolio’s market value is depressed.

The clear conclusion is that withdrawals of greater than 5.0% are a potential impediment to pursuing long-term capital growth, given the long periods required to restore capital for the various growth-oriented asset mixes offered in this analysis.

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When Was Original (12/72) Capital Restored?
  1. 0% W/D
 

  1. 5% W/D
 

  1. 0% W/D
 100% Stock  9/80(7.75 years) 6/83(10.5 years) 6/86(14.5 years)
80% Stock/ 20% Bond  9/80(7.75 years) 3/83(10.25 years) 6/86(14.5 years)
50% Stock/ 50% Bond  12/76(4.0 years) 3/83(10.25 years) 3/87(15.25 years)

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Another key issue to remember is that the withdrawal rates above are a percentage of current market value, so the dollar value of the cash withdrawn from the account is assumed to decline in a bear market.  However, most of us think of our withdrawal needs in terms of dollars instead of percentages (e.g., $50,000 from a $1,000,000 account, which translates to 5%).

If we attempt to maintain the dollar value of withdrawals in bear market periods, the percentage of current market value being withdrawn actually increases, and the impact on the portfolio far exceeds the example provided above.

SAMPLE:

To demonstrate, consider maintaining withdrawals of $50,000, $75,000 and $100,000 on an account with a $1,000,000 market value as of 12/72 (see table below).

In the case of a $50,000 annual withdrawal, approximately 8-10 years elapse before the original $1,000,000 market value is restored.  If the withdrawals are $75,000 per year, 13 years elapse for the 50/50 asset mix and almost 19 years pass for the 80/20 asset mix before the $1,000,000 is restored.  For the 100% stock portfolio, nearly 25 years elapse before the original $1,000,000 is restored.

Finally, for $100,000 withdrawals off of a $1,000,000 market value in 1972, all capital in the account is depleted within 10-15 years given these withdrawals.  Thus, the risk of significant cash withdrawals having a detrimental impact on the ability to preserve and grow capital is much more pronounced when withdrawals remain high in dollar terms.

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When Was Original Capital ($1,000,000 in 12/72) Restored?
$50,000 W/D  $75,000 W/D  $100,000 W/D
 100% Stock  3/83(10.25 years) 9/97(24.75 years) Capital Depleted9/83
80% Stock/ 20% Bond  12/80(8.0 years) 9/91(18.75 years) Capital Depleted3/85
50% Stock/ 50% Bond  9/80(7.75 years) 3/86(13.25 years) Capital Depleted9/87

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So far, the major point we have established is that a withdrawal rate of 2.5%-3.5% may be achievable without hampering the pursuit of long-term capital growth, but withdrawals of 5% or greater may have a significant impact on the ability to manage for growth.  Therefore, accounts expected to experience withdrawals of 4%-5% (or greater) should be managed with a goal of satisfying these withdrawal needs on a regular basis first, with the pursuit of capital growth taking secondary importance.

However, the analysis provided above also implies that there is a rate of withdrawals that forces us to focus on capital preservation, because depletion of capital is a likely outcome.  For withdrawals in the range of 10.0%, the example above shows that the risk of depletion of capital is significant at these high annual levels, especially if the withdrawals are on a dollar basis and not adjusted by the decline of current market value in a bear market.

In fact, with long-term U.S. government bond yields at approximately 5.0%-6.0%, annual withdrawals greater than 7.5% are likely to be too high to allow a manager to effectively pursue long-term capital growth without a high degree of risk to the capital of the account.  That is, since attempts to provide returns above the current Treasury yields imply risk of volatility, and volatility can lead to the examples provided above, withdrawals at 7.5% or more and maintained on a dollar basis imply a high likelihood that original capital will be depleted over a 15-20 year period.

In general, the current level of yields in the market imply that management of a portfolio requiring over 7.5% per year in withdrawals faces a strong possibility of depleting capital under any scenario, and so portfolio management should focus on dampening market volatility so as to extend the life of the capital for as long as possible as it is drawn down.

Final Questions

The final question[s] (i.e., the appropriate level of withdrawals) is driven by both the client’s need for the assets and the parameters outlined above:

  1. Withdrawals less than 3.5% of current market value should not inhibit the pursuit of long-term capital growth as a primary objective.
  2. Withdrawal rates between 3.6% and 7.4% require a primary focus on satisfying withdrawal needs over the market cycle, possibly with a secondary goal of long-term capital growth to protect future withdrawal needs.
  3. Withdrawal rates greater than 7.5% are likely to result in a depletion of capital, so the goal should be to manage the drawdown of capital by dampening year-to-year volatility of the portfolio.

While we all would like to achieve capital growth, the ability to pursue growth-oriented strategies depends on the flexibility to moderate withdrawals, if required by market conditions, and on the overall reliance on these assets.

As another example, an endowment can control its withdrawals to some extent, but there is a level beyond which the belt cannot be tightened without harming the services being funded.

Yet another example comes from a physician-executive or someone living primarily on an IRA account, especially after becoming accustomed to the high (and falling) interest rate/high asset return environment of the last fifteen years.  Aggressively pursuing capital growth in the face of large withdrawals may result in exposure to significant risk of depletion of the IRA assets when other sources of income are unavailable.

If, on the other hand, the IRA was a small part of the wealth available in retirement, then there is some flexibility to work towards long-term capital growth.

Financial Planning MDs 2015

Implications for defined benefit retirement plans

A defined benefit retirement plan may have an outside source of funding to help restore capital (i.e., contributions from the employer), but defined contribution and Taft-Hartley plans have much less of a safety net.  As a result, the risk taken to pursue growth in the face of significant withdrawals must take into account the nature of the assets and the problems associated with a deterioration of capital in the account.

Assessment

And so, withdrawals can have a significant impact on the ability of a manager to preserve capital and pursue long-term capital growth.  However, while lessening the level of withdrawals will help provide flexibility for the manager to pursue these goals, the need for the assets may require that withdrawals are maintained at a certain level.  Once withdrawals are minimized, the manager should focus on investment goals that correspond with this minimum level.

If withdrawals are below 3% of current market value, pursuit of long-term capital growth can be a primary objective.  Withdrawals between 4% and 7.5% of market value on an annual basis require a focus on working towards satisfying these annual needs.  Long-term capital growth, in this case, should be a secondary goal.

Finally, if withdrawals are above a 7.5% annual rate, then the investment management approach should focus on preserving capital and dampening market volatility so as to work towards allowing the assets to last as long as possible as they are drawn down.

NOTE: The 10-year Treasury rate’s just fell below 3.91% after Fed, ECB nominees; today.

Conclusion

This historical review paper provides a retrospective review of IRs and implications for modernity.

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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DAILY UPDATE: Walgreens’s Dividend Dives as Stocks Post Down Week

By Staff Reporters

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DEFINITION: A stock dividend is a payment to shareholders that consists of additional shares rather than cash. The distributions are paid in fractions per existing share. For example, if a company issues a stock dividend of 5%, it will pay 0.05 shares for every share owned by a shareholder. The owner of 100 shares would get five additional shares.

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Stat: 3.9%. That’s Walgreens’s new dividend yield after the pharmacy chain cut its quarterly dividend of 7.0%. The company said that it was using the money to “strengthen [its] long-term balance sheet and cash position.” Walgreens stock fell 11% the day after the announcement. (CNBC)

Here is where the major benchmarks ended:

  • The S&P 500 index was up 8.56 points (0.2%) at 4,697.24, down 1.6% for the week; the Dow Jones Industrial Average® (DJI) was up 25.77 points (0.1%) at 37,466.11, down 0.6% for the week; the NASDAQ Composite® (COMP) was up 13.77 points (0.1%) at 14,524.07, down 3.2% for the week.
  • The 10-year Treasury note yield (TNX) was up about 6 basis points at 4.051%.
  • The CBOE® Volatility Index (VIX) was down 0.77 at 13.36.

Consumer staples and real estate ranked among the market’s weakest performers Friday, and technology shares remained under pressure with tech bellwether Apple (AAPL) extending this week’s nearly-6% slide and ending near a two-month low. Financial shares were one of the stronger sectors with the Philadelphia KBW Bank Index (BKX) rising 1.6% to a 10-month high. Small-cap stocks remained in the red with the Russell 2000® Index (RUT) ending the week down 3.7%. 

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DAILY UPDATE: Second Apple Downgrade with Mixed Markets as Investors Await Payroll Data and Lilly Sells Medications Directly to Patients

By Staff Reporters

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 16.13 points (0.3%) at 4,688.68; the Dow Jones Industrial Average® (DJI) was up 10.15 points at 37,440.34; the NASDAQ Composite was down 81.91 points (0.6%) at 14,510.30.
  • The 10-year Treasury note yield (TNX) was up about 9 basis points at 3.997%.
  • The CBOE® Volatility Index (VIX) was up 0.08 at 14.12.

Oilfield services and consumer discretionary shares were also among the market’s weakest performers Thursday. Banking and health care were among the strongest sectors, illustrating renewed investor interest in stocks that lagged the broader market last year.

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And, Eli Lilly is poised to sell medicine directly to consumers — with an emphasis on newly popular weight-loss drugs — in a move toward cutting out the controversial middle players in drug distribution.

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DAILY UPDATE: Technology Stocks Tank on Perihelion Day

By Staff Reporters

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Today the Earth is the closest it can get to the sun, a point in orbit known as perihelion, which happens every year two weeks after the December solstice.

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SPONSOR: http://www.MarcinkoAssociates.com

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 38.02 points (0.8%) at 4,704.81; the Dow Jones Industrial Average® (DJI) was down 284.85 points (0.8%) at 37,430.19; the NASDAQ Composite was down 173.73 points (1.2%) at 14,592.21.
  • The 10-year Treasury note yield (TNX) was down about 3 basis points at 3.91%.
  • The CBOE® Volatility Index (VIX) was up 0.84 at 14.04.

In addition to tech shares, retailers and banks were also among the market’s weakest performers Wednesday. Small-cap stocks were also under pressure with the Russell 2000® Index (RUT) down about 2.7% to a three-week low. Energy shares strengthened behind a jump of nearly 4% in crude oil futures.

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PODCAST: Hospital Cost to Charge Ratios Explained

By Eric Bricker MD

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Medical Cost Accounting: https://medicalexecutivepost.com/2022/08/30/understanding-medical-cost-accounting/

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DAILY UPDATE: Apple and the “Magnificent 7” Stocks Drop with the Markets

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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Driving much of the tech slump was a 4% drop by Apple’s stock, a dive precipitated by an analyst downgrade questioning why the $2.9 trillion (market capitalization) company is trading at such an expensive valuation considering its negative earnings and profit growth.

Other members of the “magnificent seven” tech stocks, which gained a collective $5.1 trillion in market cap last year, also flailed Tuesday. Alphabet, Amazon, Meta, Microsoft, Nvidia and Meta each fell 1.6% or more, while Tesla was the sole magnificent seven member in the green, as its shares slipped less than 1% after reporting more fourth-quarter electric vehicle deliveries than fore-casted.

Here is where the major benchmarks ended:

  • The S&P 500 index was down 27.00 points (0.6%) at 4,742.83; the Dow Jones Industrial Average® (DJI) was up 25.50 points (0.1%) at 37,715.04; the NASDAQ Composite was down 245.41 points (1.6%) at 14,765.94.
  • The 10-year Treasury note yield (TNX) was up about 7 basis points at 3.931%.
  • The CBOE® Volatility Index (VIX) was up 0.73 at 13.18.

Semiconductor companies led the way lower Tuesday after Bloomberg reported Netherlands-based ASML Holding NV (ASML) canceled shipments of some of its machines to China at the request of U.S. President Biden’s administration weeks before export bans on the high-end chipmaking equipment came into effect. The Philadelphia Semiconductor Index (SOX) tumbled 3.7%. Health care and energy sectors were among the few areas of strength, the latter gaining despite a 1.6% drop in crude oil futures.

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PODCAST: Why Hospitals Cry “Poor”

By Eric Bricker MD

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DAILY UPDATE: ChristianaCare Settles FCA Lawsuit as Stock Markets Celebrate 2023 but Start Off Rocky in 2024

By Staff Reporters

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ChristianaCare agreed to pay $47.1 million to resolve illegal kickback allegations flagged by its former chief compliance officer.

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Markets: The stock market was closed yesterday to give investors time to celebrate New Year’s Day 2024. As the just passed old year, 2023, provided plenty of reasons to pop bottles and celebrate:

For example, global stock markets had their best year since 2019, and all three major US indexes finished the year higher than they started it, with tech company gains pushing the NASDAQ up the most. Even among tech giants, Nvidia was a standout, boosted by A.I. suddenly being everywhere.

But, all major markets are down as of this posting time, today.

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HELPING DOCTORS ACHIEVE: New Year Resolutions

COACHING AND MENTORING

Physician Goal Setting [Business V. Personal Approach] in 2024

By Marcinko Associates, Inc.

SPONSOR: http://www.MarcinkoAssociates.com
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CORPORATE APPROACH

The year-end physician, nurse and/or medical employee reviews in general aren’t very effective at motivating employees in ACOs, and VBC organizations, etc.

And, according to a Gallup [non-medical worker] poll, only 14% of employees “strongly agreed” that a performance review inspired them to improve. But in recent years, some workplaces have changed how they conduct performance reviews—or abandoned them altogether especially in technology.

  • A decade ago, Microsoft disbanded its version of stack ranking, the practice pioneered by General Electric CEO Jack Welch in the 1980s in which the company would rank every employee. Experts say it hurts morale and can create a toxic work culture.
  • Netflix has around 10,000 employees but has eschewed the year-end review for informal conversations during the year.
  • Google revamped its system last May by reducing performance reviews from twice to once a year.
  • Apple dropped performance reviews completely.

Healthcare business and corporate employees want feedback, even physicians, but it has to be useful.

PERSONAL APPROACH

Now that you’ve set your personal goals on your landmark date (New Year 2024), how you pursue it will go a long way toward whether you achieve it. There are generally two ways to tackle the goals you’ve set for yourself—and one yields more success than the other.

  • Avoidance goals: While this works well when it comes to your ex-medical partner or spouse, it’s not how you want to attack resolutions. Avoidance goals include “stop eating sweets” or “watch less TV.”
  • Approach goals: Instead of avoiding a behavior, you create a new one. Your goals would be “eating more vegetables” or “reading more books” to replace the habits you want to shake.

And, a recent study found that approach goals are more likely to be accomplished (59%) than avoidance goals (47%) across a wide range of potential resolutions. Good luck with that!

WE CAN HELP.

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HAPPY NEW YEAR: From All of Us at the ME-P

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EDUCATION: https://marcinkoassociates.com/textbooks-academic-catalog/

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 From us all to you and yours.
Here’s to making a difference and paying it forward today, in 2024, and beyond. 

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